Exploring Licensing and Certification for Aesthetic Nurses

These examples are intended to provide information and inspiration for your journey and are not a recommendation or endorsement.

Connie Brennan started working as a registered nurse in the late 1980s and remembers when the first neurotoxin and hyaluronic acid fillers came to market in the early 2000s. She began injecting before there was an Internet to find resources, before there were social media platforms, and before most plastic surgeons embraced the aesthetics side of their practice.

“There was no formal guide to the nonsurgical side of aesthetics,” says Brennan, who is now licensed as an RN in 10 states. “I had to navigate it as I went and try to learn by asking questions to every surgeon, nurse, aesthetician, and office manager I worked with.”

Today Brennan, MSN, RN, PHN, CANS, CPSN, CPC, ISPAN-F, is a national aesthetic education director at a med spa in St. Louis Park, Minnesota, and founder and president of a Medical Aesthetics consulting/training company. After rising through the industry with limited aesthetic training options, Brennan is eager to spread the knowledge that she had to scramble to acquire.

See how her experience—and her advocacy on behalf of her fellow registered nurses—may help you navigate your own path to a career in Medical Aesthetics.

At first, Brennan didn’t know how to become licensed and certified in this new field.

After passing her nursing exams and earning her original state licensure in Minnesota, Brennan reports being “a little clueless” about next steps, since “there really weren't any certifications back then that were important for Medical Aesthetics—because they didn't exist,” she says. She was able to pursue a certification for plastic surgery nurses but it didn’t cover injectables. To make things more confusing, the certificate she received did not automatically confer any authority. “What people don't understand is that just because you have a certificate in aesthetic procedures training, it doesn't necessarily mean you've mastered anything,” Brennan says. Don’t misunderstand—pursuing a certification shows that you’ve taken the initiative to learn more about a specific topic and have passed a test, however, “it just shows that you've participated,” she says.

Over a decade ago, a handful of nurses joined Brennan in seeking an official certification for Medical Aesthetics by working with ISPAN, the International Society of Plastic and Aesthetic Nurses, putting together the task force that designed the Certified Aesthetic Nurse Specialist (CANS) exam, a rigorous certification test of the Plastic Surgical Nursing Certification Board, Inc. (PSNCB) that validates their specialty knowledge in Medical Aesthetics. It is also the only one of its kind as an aesthetic nurse certification.

At the time a nurse applies to sit for the CANS exam, applicants must:

• Be currently licensed as a registered nurse (RN) with an associate or bachelor’s degree in nursing or a nurse practitioner (NP) with a master’s degree in nursing.
• Have spent at least 1,000 practice hours within the core specialties during the last two years.
• Have a minimum of two years of nursing experience as a registered nurse with a physician who is board-certified within a core specialty.
• Currently work with a board-certified physician within one of the following specialties: plastic/aesthetic surgery, ophthalmology, dermatology, or facial plastic surgery.
• Have a supervising licensed physician endorse their application.¹

CANS certifications last for three years, after which applicants must reapply for or retake the assessment along with 45 hours of continuing medical education (CME).

Brennan discovered that different states have different requirements.

Every state has its own process of licensing aesthetic nurses, but some states have banded together with their neighbors to form “compact states,” such that if you are licensed in one state, you are automatically licensed to practice in all the states within that compact, Brennan explains. Minnesota uses a single state license and is not part of a compact, so Brennan has had to apply to her state separately to become licensed there. What’s more, every state has different requirements for continuing medical education (CME). “It's a part-time job keeping up with the 10 state licenses that I have because they're all due at different times,” Brennan says. “You have to make sure your CME’s fall within that time frame and that you have an affidavit showing that you’ve met those responsibilities.”

If you’re an RN, first “look at your own state licensure guidelines to check whether or not it is part of a compact,” Brennan advises. “Then, if you decide to teach in another state or have a clinic in California and a clinic in Minnesota, you’d need to get two licensures and two physicians who are licensed within that state to be your medical director,” she explains. There are different requirements for nurse practitioners (NPs), and Brennan is in the process of pursuing her NP license now. “But those are things that you really want to check on with your state licensure and know your own,” she says. “If you decide to transition to another state, make sure you understand those state licenses too because they're going to be different.”

Brennan has earned and must keep up with all her licenses and certifications.

She explains what it takes to earn and maintain each of these credentials (always check your state guidelines for more information):

• Registered Nurse (RN)—Requires a 2-year Associate of Science degree in nursing.²
• Master of Science in Nursing (MSN)— A 2 – 3 year program with a 4-year Bachelor of Science in Nursing degree prerequisite.³
• Public Health Nurse (PHN)—Part of the BSN degree but requires separate certification.⁴
• Certified Plastic Surgery Nurse (CPSN)—Earned through the International Society of Plastic Surgery Nurses; must be a 2-year aesthetic nurse; requires recertification every 3 years.⁵
• Certified Aesthetic Nurse Specialist (CANS)—Earned through the International Society of Plastic Surgery Nurses after criteria has been met. Requires recertification every 3 years.⁶
• Certified Professional Coach (CPC)—A hands-on certification for coaching and teaching; requires recertification every 4 years.⁷
• International Society of Plastic and Aesthetic Nurses Fellow (ISPAN-F)—a lifetime honor bestowed by the society on invited applicants who are also board-certified by the Plastic Surgical Nursing Certification Board.⁸

This is the best place to start with licensing and qualifications, according to Brennan.

“Your number one resource is your state boards—as a PA, nurse, MA, aesthetician, physician—because those are all boards that you have to follow,” Brennan says. And then there are professional organizations for nurses, MDs, dermatologists, plastic surgeons, and medical spas that can provide legal assistance as well as classes. Brennan also recommends aesthetic training companies that can match you with a clinic that’s looking for someone like you and will train you directly. “I think it's nice because some nurses don't have the resources to pay for their own training when the training companies are charging some $6,000 for a day or $12,000 for a weekend,” she says. “So, if they can be trained by a company who wants to hire them, they're really happy with that.”

Brennan has found that some certificates, while not required, can be advantageous.

Those “neurotoxin/filler certificates” that some manufacturers and training companies offer are not prerequisites for a job as an injector, but they may show initiative. “It shows that you’ve taken a proactive step toward learning,” Brennan says. “And that's helpful for your resume—a little extra ticket to get in the door.” The certificates are not technically required, however.

“Whether you can inject independently or not goes according to your licensure,” she adds.

"Your number one resource is your state boards—as a PA, nurse, MA, aesthetician, physician—because those are all boards that you have to follow,” Brennan says.

Why Brennan believes that finding the right medical director may be key to your success.

Whether you need a medical director or not comes down to state regulations. “Anytime you’re injecting a medication, it requires medical training. Depending on the state, can that medicine be injected by a nurse, a nurse practitioner, a doctor, a PA, an LPN, or an MA?” Brennan says. “Who can inject medication in that state? Can they inject it on their own without a physician being present? And would you be considered an independent provider as a PA, NP, an MD?” When it comes to injecting medicine—and neurotoxins are considered medicine—you may need a medical director if you’re not licensed to do it independently in your state.

In Minnesota, as an RN, Brennan needs a medical director who is a physician or a nurse practitioner to sign off on neurotoxin and filler orders, in patient charts, and to sign off on product in order for staff to receive training. The medical director is responsible for ordering the medications because the accounts are set up under them. Your state guidelines will also determine whether the medical director needs to be on-site or within a certain call distance.

The best medical directors, according to Brennan, are practitioners who know what you're doing so that they can help you at all times. “Because if you have a problem, you should be able to call on your medical director,” Brennan says. “Their license would be the one you fall back on. A medical director has to take responsibility for what could happen.”